Intracytoplasmic sperm injection (ICSI)

Intracytoplasmic sperm injection (ICSI) is a method of assisted reproductive technologies (ART) used to treat male infertility. During the ICSI procedure, a single spermatozoon is injected directly into the cytoplasm of a mature egg, which helps overcome problems associated with low sperm quality or quantity. This method is used within in vitro fertilization (IVF) cycles when conventional fertilization techniques are ineffective.

ICSI is most commonly used in the following cases:

1. Low sperm count or poor sperm quality: when too few spermatozoa are present in the ejaculate or they exhibit low motility (asthenozoospermia), as well as abnormal sperm morphology (teratozoospermia).
2. Azoospermia: complete absence of spermatozoa in the ejaculate. In such cases, sperm may be retrieved by testicular biopsy (TESA) or epididymal aspiration (PESA).
3. Presence of antisperm antibodies: some men have antibodies that bind to spermatozoa and interfere with their normal function and the fertilization of the egg.
4. Previous unsuccessful IVF attempts: ICSI may be used when standard IVF methods have proven ineffective and have not resulted in fertilization.
5. Frozen spermatozoa: when using cryopreserved sperm, which may have reduced motility and quality after thawing, the ICSI method can increase the likelihood of successful fertilization.

How is the ICSI procedure performed?

The ICSI procedure in Belarus is carried out in several stages, including ovarian stimulation in the woman, retrieval of eggs and spermatozoa, injection of the spermatozoon into the egg, and subsequent embryo transfer into the uterus.

1. Ovarian stimulation: prior to ICSI, the woman undergoes ovarian stimulation with the use of hormonal medications that promote the growth and maturation of multiple oocytes. This is necessary to increase the chances of successful fertilization and development of a healthy embryo.
2. Follicular puncture and egg retrieval. Once the eggs reach the required level of maturity, follicular puncture is performed under ultrasound guidance. The eggs are retrieved from the ovaries and placed in a special culture medium to prepare them for fertilization.
3. Sperm retrieval: spermatozoa may be obtained through conventional ejaculation or, if this is not possible, by testicular biopsy (TESA/PESA). In the laboratory, the embryologist selects the highest-quality spermatozoa for injection.
4. Sperm injection (ICSI). During ICSI, the embryologist uses a microscope and a special micromanipulation tool to inject a single spermatozoon directly into the cytoplasm of the oocyte. This makes it possible to overcome problems related to insufficient sperm motility or inability to achieve natural fertilization.
5. Fertilization assessment. After the ICSI procedure, the egg is placed in an incubator, where fertilization is assessed over 16–20 hours. If fertilization is successful, the cell begins to divide and develops into an embryo.
6. Embryo transfer into the uterus. Three to five days after fertilization, one or more embryos are transferred into the uterine cavity. The embryo transfer procedure is painless and performed using a thin catheter. If the embryo implants in the uterus, pregnancy begins.

ICSI makes it possible to overcome most problems related to sperm quality and to successfully use spermatozoa even in severe forms of male infertility.

Although ICSI is a safe and effective procedure, like any medical method it carries certain risks:

• Multiple pregnancy. When multiple embryos are transferred, there is an increased risk of multiple gestation, which is associated with complications for both the mother and the children.
• Genetic abnormalities. In rare cases, ICSI may be associated with an increased risk of genetic abnormalities in the fetus, particularly when infertility is related to chromosomal structural disorders.
• Ovarian hyperstimulation syndrome (OHSS). During ovarian stimulation, some women may develop OHSS, which is accompanied by ovarian enlargement, abdominal pain, and other symptoms.

Intracytoplasmic sperm injection (ICSI) in Belarus is an advanced and highly effective assisted reproductive technology used to overcome male infertility. Thanks to the direct injection of a spermatozoon into the egg, ICSI helps couples achieve pregnancy even in the most complex cases.